ROY WEISS, INC.

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

GOLF SHACK RETIREMENT PLAN

2009

371396387

2010-06-21

GOLF SHACK, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1974-02-15
Business code	423910
Sponsor’s telephone number	8153973709
Plan sponsor’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107

Plan administrator’s name and address

Administrator’s EIN	371396387
Plan administrator’s name	GOLF SHACK, LLC
Plan administrator’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107
Administrator’s telephone number	8153973709

Signature of

Role	Plan administrator
Date	2010-06-21
Name of individual signing	TODD POLIVKA
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2010-06-18
Name of individual signing	TODD POLIVKA
Valid signature	Filed with authorized/valid electronic signature

GOLF SHACK RETIREMENT PLAN

2009

371396387

2010-06-21

GOLF SHACK, LLC

Three-digit plan number (PN)	001
Effective date of plan	1974-02-15
Business code	423910
Sponsor’s telephone number	8153973709
Plan sponsor’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107

Plan administrator’s name and address

Administrator’s EIN	371396387
Plan administrator’s name	GOLF SHACK, LLC
Plan administrator’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107
Administrator’s telephone number	8153973709

Signature of

Role	Employer/plan sponsor
Date	2010-06-18
Name of individual signing	TODD POLIVKA
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role
ROY WEISS, 122 COLLINSVILLE AVE, E ST LOUIS, 62201, ST. CLAIR	Agent

Name and Address	Role
BERNARD REISS, #5 CLAY PRICE CT SAINT LOUIS MO 63124	President

Class	Series	Voting Rights	Authorized Shares	Issued Shares	Par Value
COMM	No data	Voting Rights	1500	1500000	100

Date of last update: 23 Dec 2024